Gliederung

Objective

Selection criteria for patients with chronic hydrocephalus are still enigmatic. Objective of this prospective study was to find outcome predictors for patients with chronic hydrocephalus (CH).

Methods

125 patients with chronic hydrocephalus of various origins were examined. CSF-dynamics, length of anamnesis, preoperative clinical state, age and Co-morbidities (with a new ranking scale: Co-Morbidity-Index (CMI)) were examined as outcome predictors. All patients received a gravitational valve. Outcome was measured with an own classification (HHS) and with Black’s scale. Statistics: Spearman-test, Kruskal-Wallis-test, U-test at a significance level <0.005.

Results

ROF alone had a positive predictive value (PPV) of 63% and a negative predictive value (NPV) of 37%. PPV and NPV of PVI were somewhat better. However the combination of ROF and PVI provided the best PPV (79%) and NPV (68%) regarding CSF-dynamics. Statistically significant correlations were found between outcome and length of a anamnesis (p=0.001), preoperative clinical state (p=0.003) and Co-morbidity state (p=0.001), which had a negative influence on regeneration potential. Cerebral white matter disease (CWD), hypertension, diabetes mellitus, presence of M.Parkinson and a generalized occlusive vascular disease had the utmost negative effects, while a preceding cardiac disease influenced outcome not. Age is not an independent predictor of outcome. If Co-Morbidity is low (CMI < 3 points) and / or preoperative clinical state exhibits only a moderate obstruction (HHS < 6 points) the probability for a substantial clinical benefit from shunting is >90%.

Conclusions

Shunt surgery should be performed as early as possible, because the rehabilitation potential decreases with an anamnesis longer than 1 year. To wait for the complete Hakim Trias is unfounded. Delayed surgery is only acceptable, if clinical obstructions are mild and Co-Morbidity is low. Patients’ age per se may not be taken as an argument against surgery, if Co-Morbidity is low or clinical obstruction is mild. Of utmost importance is the co-morbidity state. If CMI is > 3 points rehabilitation chances fall dramatically. In the light of invasiveness the value of CSF-hydrodynamics is disputable regarding the predictive value.